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Side effects of chemotherapy for acute lymphoblastic leukaemia

Most people with acute lymphoblastic leukaemia have a combination of 2 or more chemotherapy drugs. There is information about the drugs you are most likely to have and links to information about their specific side effects further down this page.

ALL chemotherapy side effects

Drugs affect people in different ways. It is not possible to tell how you will react until you have a particular drug. The common side effects with treatment for ALL are

Low numbers of white blood cells, red blood cells and platelets

Feeling and being sick

Complete hair loss but the hair grows back after treatment

A sore mouth and mouth ulcers

Diarrhoea

Tiredness

Changes in fertility – the treatment may make you infertile, temporarily or permanently

All the drugs used to treat ALL will make your blood cell counts fall. You will be at risk of infection for a few weeks after your treatment. During ALL treatment, most people will need antibiotics into a vein for infection at some time.

You may need blood transfusions to top up your red blood cells. You will also have a low platelet count at some point in your treatment. This means you are at risk of bleeding or bruising. You can have a platelet transfusion to top up your platelets.

The links take you to information about the specific side effects of each of these drugs. You won’t have all of those listed here. Your doctor or specialist nurse will tell you which ones you will have.

For remission induction most people have a combination of drugs which starts with vincristine, a steroid (such as prednisolone) and a type of chemotherapy called an anthracycline – daunorubicin or doxorubicin. You may also have asparaginase.

Consolidation treatment is more chemotherapy. The type of chemotherapy you have depends on which consolidation treatment you have. A typical combination includes doxorubicin, asparaginase, methotrexate and cytarabine. You may have radiotherapy as part of a bone marrow transplant.

The chemotherapy drugs you are likely to have for maintenance treatment include methotrexate, vincristine, prednisolone and mercaptopurine.

Side effects of chemotherapy for ALL

Drugs affect people in different ways. Not everyone has the same side effects with the same drug. It is not possible to tell how you will react until you have a particular drug.

The common side effects you are likely to have with treatment for acute lymphoblastic leukaemia are

A drop in your blood cell counts

Feeling and being sick

Complete hair loss

A sore mouth and mouth ulcers

Diarrhoea

Tiredness

Loss of fertility

All the drugs used to treat ALL will make your blood cell counts fall. This includes your red blood cells, platelets and white blood cells. You will be at risk of infection for a few weeks after your treatment. During ALL treatment most people need antibiotics into a vein at some point, to treat infection.

After about a month, you will be at risk of a low red blood cell count (anaemia) and may have blood transfusions to top up your red cells. You will also have a low platelet count at some point in your treatment. This means you are at risk of bleeding or bruising. You can have platelet transfusions to top up your platelets.

These drugs will also make your hair fall out. All your hair will grow back after your treatment is over. But during your treatment, you will lose

The hair on your head

Your body hair

Your eyebrows and eyelashes

The hair inside your nose – so your nose will run more than usual

Unfortunately chemotherapy for adult leukaemia will probably make you infertile, either temporarily or permanently. Men may be able to store their sperm to use in the future. It may be possible for women to store their eggs. But this is unlikely as you usually need to start treatment straight away, and egg collection takes a few weeks. If fertility is important to you, talk to your doctor or specialist nurse as soon as possible.

Drugs to control the effects of ALL treatment

Chemotherapy drugs can cause some effects that need to be controlled. Substances from dying leukaemia cells can cause problems with your liver and kidneys. This is called tumour lysis syndrome. To control this, you may have medicines such as allopurinol tablets. These tablets help the body to process the waste materials from the dead leukaemia cells. If your white blood cell levels are very high, or if you have T cell ALL, you may have a medicine called rasburicase by drip, instead of allopurinol tablets.

Chemotherapy drugs increase your risk of infection. To help stop you getting infections from the natural bacteria that live in the gut, you may be given tablets called gut sterilisers. You may also need tablets and mouthwashes to help stop mouth infections, such as thrush.

Supplements and herbal treatments and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

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